Sarah Anderson, an ophthalmologist with the U.K.'s National Health Service (NHS), provides a first-hand account of the country's 'postcode lottery,' a system which decides who gets vital drugs based on where a person lives.

Anderson's father, Ian, has been refused Sutent, a new cancer drug, which could provide the only real chance of treating his kidney cancer. Although Sutent has been licensed in Europe since 2006, the U.K.'s National Institute of Clinical Excellence has yet to decide whether it is effective enough to warrant the cost to the NHS.

It is not due to pass judgment until next January, and in the meantime, each Primary Care Trust (responsible for the health services of the local population) is entitled to form their own policy on its use.

Of the 3,100 patients a year who discover that they have advanced kidney cancer, fewer than 200 have succeeded in getting funding for the drug from their PCT. "I never for a moment thought that a life could be decided by something as arbitrary as one's address," she writes.

James Gubb of the London-based think tank Civitas argues that patients should be able to buy such treatments privately. Implicit rationing — clinicians hiding, or placing limits on, the range of choices available to patients under the guise of clinical necessity — has enabled the more affluent and articulate to gain preferential treatment, writes Gubb.